Background: The increasing use of patient-reported outcome measures in clinical research and care across all medical disciplines requires an understanding of the nonclinical variables that affect these measures. Participation in medical malpractice litigation, as is common following neonatal brachial plexus palsy, may be an important confounder of parent or patient-reported outcomes.
Methods: This multicenter, case-control study includes patients two to eighteen years of age with neonatal brachial plexus palsy seen at three tertiary brachial plexus centers from January 1990 to December 2011. Public court records were searched for litigation details. Families with and without medical malpractice litigation were matched on age and injury severity (by Raimondi scale and Mallet classification). Parent or patient-reported outcomes, measured by the Pediatric Outcomes Data Collection Instrument, were compared between litigation and non-litigation cohorts.
Results: Of 334 patients from eighteen states, seventy-five (22%) were plaintiffs in medical malpractice lawsuits. When matched on patient age and injury severity, parents reported their children to have worse mobility (p = 0.04), sports or physical function (p = 0.003), and global function (p = 0.02) in the litigation cohort compared with the non-litigation cohort. Parents in active lawsuits reported their children to have greater pain (p = 0.046) compared with children of parents in closed lawsuits, when controlling for patient age and injury severity. Outcomes scores simultaneously obtained from patients and parents differed in the litigation cohort, with parents reporting their children to have worse upper-extremity function (p = 0.03) and global function (p = 0.008) than their children reported.
Conclusions: Litigation is associated with worse parent reports of children’s function and pain following neonatal brachial plexus palsy, independent of age, injury severity, and the patients’ own report of their function. Litigation status should be considered a confounding variable in the use of parent-reported outcomes in neonatal brachial plexus palsy research. Parents involved in litigation may benefit from additional support.
1Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 2017, Cincinnati, OH 45229. E-mail address for R. Cornwall: firstname.lastname@example.org
2Division of Pediatric Orthopaedic Surgery, Shriners Hospital for Children Northern California, 2425 Stockton Boulevard, Sacramento, CA 95817
3Department of Orthopaedic Surgery, Shriners Hospital for Children Philadelphia, 3551 North Broad Street, Philadelphia, PA 19140